Coding Auditor

Health Business Solutions LLC; Manila; On-site; PHP 334,800 - 558,000; Full time

Job summary

A leading healthcare outsourcing firm is seeking a Coding Auditor to review and audit medical records, ensuring accuracy and compliance with coding standards such as ICD-10 and CPT. The ideal candidate should have 2-3 years of experience in medical coding or auditing, relevant certifications, and a bachelor's degree in a related field. You will educate teams on coding practices and prepare detailed audit reports while supporting the revenue cycle management process. This role is essential for ensuring high coding standards and compliance in healthcare documentation.

Qualifications

• Certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or similar certification is required.
• Experience: Minimum of 2-3 years of medical coding or auditing experience.
• Strong knowledge of ICD-10, CPT, and HCPCS coding systems.

Responsibilities

• Conduct audits of medical records to ensure accurate coding.
• Ensure all coding aligns with federal and state regulations.
• Educate coding staff and healthcare providers on accurate coding practices.

Skills

Attention to Detail

Communication Skills

Analytical Skills

Knowledge of Coding Systems

Familiarity with Compliance Standards

Education

Bachelor's degree in Nursing or related field

Tools

Epic

3M Encoder

Cerner

Job description

Health Business Solutions (HBIZ), founded in 2002, is a high-impact, transitional outsourcing firm that provides near-term relief to overturn denied claims and accelerate cash while concurrently working with providers and health systems to address Revenue Cycle under-performance.

The Coding Auditor will perform detailed reviews of medical documentation and coding, ensuring accuracy, compliance with coding standards, and adherence to regulations such as ICD-10, CPT, and HCPCS. The auditor will work closely with coding teams, providers, and clinical staff to educate on coding practices and provide feedback for continuous improvement.

Key Responsibilities

• Review and Audit Medical Records: Conduct audits of medical records to ensure that coding is accurate, compliant with payer requirements, and adheres to national coding guidelines (ICD-10, CPT, and HCPCS codes).
• Ensure Regulatory Compliance: Ensure all medical coding aligns with applicable federal, state, and local laws and regulations (including Medicare and Medicaid guidelines).
• Identify Errors and Gaps: Detect and correct coding discrepancies, missing or incomplete documentation, and over- or under-coding issues.
• Provide Feedback and Education: Educate coding staff and healthcare providers on accurate coding practices, documentation improvement, and regulatory changes.
• Prepare Audit Reports: Compile detailed audit reports highlighting findings and corrective actions needed, including recommendations for process improvement.
• Support Revenue Cycle: Work closely with the revenue cycle management team to ensure proper coding for billing and reimbursement.
• Keep Up to Date with Coding Changes: Stay current with updates to coding standards, compliance regulations, and healthcare laws.

Required Skills & Qualifications

• Certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), or similar certification is required.
• Experience: Minimum of 2-3 years of medical coding or auditing experience and experience with risk adjustment audits, clinical documentation improvement (CDI), and payer audits.
• Knowledge of Coding Systems: Strong knowledge of ICD-10, CPT, and HCPCS coding systems, and familiarity with DRG, E/M coding.
• Bachelor's degree: in Nursing, or any Medical or Health Information Management or a related field.
• Attention to Detail: Exceptional attention to detail with the ability to identify coding and documentation errors.
• Communication Skills: Strong written and verbal communication skills, with the ability to provide feedback to coding teams and clinicians.
• Analytical Skills: Ability to analyze data and develop insights that drive improvements in coding accuracy and compliance.
• Familiarity with Compliance Standards: Knowledge of healthcare compliance standards such as HIPAA, Medicare, and Medicaid regulations.
• Proficiency in Software: Experience using coding and billing software (e.g., Epic, 3M Encoder, Cerner, or other EHR systems).